A controlled trial to improve delivery of preventive care

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Abstract
Objective:To improve the delivery of preventive care in a medical clinic, a controlled trial was conducted of two interventions that were expected to influence delivery of preventive services differently, depending on level of initiative required of the physician or patient to complete a service. Design:A prospective, controlled trial of five-months’ duration. Setting:A university hospital-based, general medical clinic. Participants:Thirty-nine junior and senior medical residents who saw patients in stable clinic teams throughout the study. Intervention:A computerized reminder system for physicians and a patient questionnaire and educational handout on preventive care. Measurements and main results:Delivery of five of six audited preventive services improved significantly after the interventions were introduced. The computerized reminder alone increased completion rates of services that relied primarily on physician initiative; the questionnaire alone increased completion rate of the service that depended more on patient compliance as well as on some physician-dependent services. Both interventions used together were slightly less effective in improving performance of physician-dependent services than the computerized reminder used alone. Conclusions:These interventions can improve the delivery of preventive care but they differ in their impacts on physician and patient behaviors. Overall, the computer reminder was the more effective intervention.